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Health and homelessness: Understanding the costs and role of primary care services for homeless people

It is widely known that homelessness, especially rough sleeping, has significant and negative consequences for an individual’s health. Many studies have found strong correlations between homelessness and a multiplicity, and increased severity, of both physical and mental health conditions

However, despite this increased morbidity, homeless people consistently miss out on the healthcare they need. As a result, health problems are left untreated and health deteriorates. When homeless people do access health services, they are likely to do so in an unplanned way (for example through accident and emergency) and to be in a state of chronic ill health. This results in longer stays in hospital and multiple readmissions, and has clear cost implications for the NHS.

While there has been some evidence to date on the cost of use of health services by homeless people and the cost benefit of health services for homeless people, there remain gaps in the evidence base, in particular regarding homeless people’s use of primary health services.

As part of the Inclusion Health Programme’s work to understand and address the health needs of the most excluded, the Department of Health commissioned St Mungo’s to investigate the extent to which evidence to address this gap exists.

The report is based on consultation with six services providing health care to homeless people, 17 case studies showing the range of presenting health issues and use of health services by homeless people, and analysis of five case studies illustrating the financial impact of this pattern of service use.